Provider Demographics
NPI:1891861621
Name:REED, KENNETH F (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:F
Last Name:REED
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15832 VENTURE LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5732
Mailing Address - Country:US
Mailing Address - Phone:952-906-2993
Mailing Address - Fax:952-906-2993
Practice Address - Street 1:15832 VENTURE LN
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5732
Practice Address - Country:US
Practice Address - Phone:952-906-2993
Practice Address - Fax:952-906-2993
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2008103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist